title: Physiology of the small bowel: a new approach using MRI and proposal for a new metric of function.
abstract: BACKGROUND
  The mechanics of small bowel motility are extremely complex. Routine clinical access to small bowel has been restricted to radiological enteric contrast studies which have not contributed significantly to the understanding of small bowel physiology. Small bowel mechanics are understood within a framework of individual visible or measurable elements such as peristaltic wave formation, intra-luminal pressure gradients and transit times. There are no global measures of small bowel function that can be readily obtained in vivo in humans. Magnetic resonance imaging (MRI) is playing an increasingly important role in radiological diagnosis of small bowel disease and dynamic MRI offers the possibility of capturing small bowel movement in three-dimensional cinematic datasets. The metrics that are used to describe small bowel mechanics, typically anatomical measures in isolated segments, are not suited to analysing these large dynamic datasets. The proposal in this paper is to leave behind all previously described anatomical metrics and to describe anew the mechanics of small bowel movement in mathematical terms derived from changes in pixel intensity within dynamic MRI datasets so that global small bowel activity might be summarised in a single novel metric.
  
  
  OBJECTIVE
  The hypothesis of this paper is that global small bowel activity can be quantified by a new dynamic MR based metric.
  
  
  RESULTS
  A proposed strategy for evaluation includes a progression through feasibility, optimisation, reliability and validation studies. Thereafter normal volunteers would be required in order to define normal ranges for the new metric. These ranges would describe small bowel activity during fasting or after ingestion of fluids and standard meals. Mathematical modelling of the data could follow a two stage approach. The first stage could be to study segmentation or extraction techniques by which the small bowel activity could be isolated from MRI signal generated by the rest of the abdomen. The second stage would be to apply a number of data mining techniques that would identify significant features within the datasets.
  
  
  CONCLUSIONS
  If this approach proves to be a useful model for studying small bowel physiology in humans, it would afford significant new avenues of research and treatment particularly in areas such as enteric drug delivery, the ageing gut, and nutrition.
authors.affiliation: Norwich Radiology Academy, Cotman Centre, Colney Lane, Norwich, Norfolk NR4 7UB, UK. andoni.toms@nnuh.nhs.uk
authors.forename: Andoni P
authors.initials: AP
authors.lastname: Toms
authors.forename: Aser
authors.initials: A
authors.lastname: Farghal
authors.forename: Bahman
authors.initials: B
authors.lastname: Kasmai
authors.forename: Anthony
authors.initials: A
authors.lastname: Bagnall
authors.forename: Paul N
authors.initials: PN
authors.lastname: Malcolm
mesh_terms: D005769:Gastrointestinal Motility; D006801:Humans; D007421:Intestine, Small / Q000502:physiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*